Transcript

Today on The Health Report, find out when it's safe to pass water, when it's safe to drink it, what's in our water as a result of keeping it clean, plus the havoc that ducks can wreak. Yes, ducks.

And, the Olympics, where clean water is just one of the concerns for the public's health when hundreds of thousands of people drop into Sydney from around the world. They'll concentrate at venues where bioterrorism and many epidemics are small, but real, risks. And in cruise liners on the harbour, which apparently are potential breeding grounds for all sorts of germs.

Dr Andrew Wilson is the Chief Health Officer for New South Wales and has been overseeing the measures being taken to protect our health during the Games.

Andrew Wilson: This is the largest sporting event in the world, in terms of the duration of the event and in terms of the sorts of crowds which are expected to attend over the just over two week period of the games.

Norman Swan: How long have you been planning for it, in the public health sense?

Andrew Wilson: We've been going for at least two years now, and before that there was some provisional planning going on.

Norman Swan: Just give us the scope, the logistics; what are you expecting in terms of crowds, new facilities, that sort of thing, that give you cause for potential concern?

Andrew Wilson: The real challenge here is not so much in the size of the crowd but in the fact that this is an event which goes over two weeks. With New Year's Eve, for instance, we deal with crowds of over a million people coming into the city, and we're not expecting crowds consistently at that sort of level during the Olympic period. But every day at the Homebush site, there will almost certainly be over a couple of hundred thousand people, and during the changeover periods between sessions, there particularly will be large numbers of people at the Homebush site.

Norman Swan: How many people are coming into the city? And I'm told the harbour's going to be full of cruise ships.

Andrew Wilson: The current estimates are there is going to be something like 350,000-plus overseas visitors coming to Sydney. It's been more difficult to estimate the number of Australian residents who are coming to Sydney for that period of time, and as part of the process for providing accommodation for those large crowds, there are going to be some nine cruise ships anchored in the harbour to provide accommodation.

Norman Swan: 300,000 doesn't seem like a lot. Is that fewer than you thought there were going to be?

Andrew Wilson: 300,000-plus, we're talking about the number of overseas visitors. There will almost certainly be a lot more than that once you take in local visitors.

Norman Swan: Now that number of people coming in at the one time, does that itself present a public health hazard, that people are arriving potentially with all sorts of exotic things, or will most of them be coming from places like Dallas or Los Angeles?

Andrew Wilson: One of the features of the modern world, with people commuting around the place, has been a growing problem of people who rapidly transfer from one country to another and in that process can bring with them, illnesses. So when you've got a situation like this with a very large number of people coming from overseas, that's clearly one of the issues that we have to be really prepared for.

Norman Swan: How can you prepare for it?

Andrew Wilson: Well we have to be hyper-vigilant, and one of the key strategies we've developed for this is the development of a hyper-surveillance network during the period of the Games. So normally we carry out a process where we have notifications from laboratories and emergency departments about unusual events or particular notifiable diseases. During this period we will be linking together a whole range of different places which can give us information about that. So we'll be linking both the hospitals, particularly the key hospital emergency departments around Olympic sites and around the city, our normal laboratory notification system; we will have proactive assessment of this, we'll have public health teams out there looking for problems, we'll have notifications coming from the Games sites itself and from the health clinics at the Games sites, and we'll have live data coming from the ambulance system about notifications. And by bringing this things all together, we'll have a virtually instantaneous picture of what's happening in terms of health around the city.

Norman Swan: Now nine cruise liners, what? with 6,000 or 7,000 people on them in the harbour, that's a public health hazard in itself, isn't it?

Andrew Wilson: We're certainly concerned that that is one of the key areas that we need to really be on top of. There have been events here in Australia, and certainly overseas, where small epidemics have occurred on board cruise liners; it's the nature of that sort of closed environment.

Norman Swan: Food-borne disease?

Andrew Wilson: Food-borne disease is the particular hazard in that situation, but overseas there have been, for instance, examples of clusters of tuberculosis occurring on cruise liners, or as a result of people travelling on cruise liners. We've been working with the Centre for Disease Control in Atlanta in the US in an extension of the program which has been running in the US for some ten years now, called the Cruise Ship Inspection Program. This Program works collaboratively with the owners of the ships to ensure that the ships involved come up to certain standards, that they meet very stringent public health standards.

Norman Swan: What happens to the poo?

Andrew Wilson: The ships of course have the capacity to store sewerage.

Norman Swan: They've also a capacity to discharge it.

Andrew Wilson: And one of the key elements of this is to ensure that the discharge from the ships actually goes into the sewerage systems, and ensuring that it does so safely and without risk of contamination to the harbour.

Norman Swan: What's the potential for disaster?

Andrew Wilson: From the start, that has been a concern that's been raised. Obviously past experiences in relation to Olympics have made people very conscious of this, and the sort of hyper-anxiety almost, around the world at present in relation to disaster preparedness and terrorism, particularly in the US, has meant that that's been a very important part of our agenda since the beginning of this planning. We believe that the risks are relatively small of any form of disaster, but you've got to be prepared for the worst, and that's what we've been preparing for.

Norman Swan: How?

Andrew Wilson: One of the real legacies from the Olympics from our perspective will be that we've had an opportunity to do a lot of training of staff in disaster preparedness, in being prepared for things like chemical and biological hazards, exposures to people in the community, and so we've had a very active training program for clinical staff, ambulance staff, over the past 12 months. We've revised all our disaster protocols, how we handle these things; we've got new equipment to assist in the preparation of that. And we've also undertaken a number of disaster scenarios.

Norman Swan: How realistic are those? Because they've had a bit of publicity.

Andrew Wilson: They're as realistic as we can possibly make them.

Norman Swan: So people know a scenario's coming up at some point, but they don't know when and they don't know what it is.

Andrew Wilson: Well the balance is always to try and not totally disrupt everybody's lives to run these disaster scenarios, so you have some advance warning of them, but in general, the nature of the event is kept quiet until the actual day when it occurs and then the beeper goes off and we get told that there is an event that's running and that we're part of it.

Norman Swan: So what was the last one that you had, the last disaster scenario?

Andrew Wilson: The last pretend disaster, let's be clear about that. Most of the disaster scenarios we've been running have been a mix of different types, and that's as a way of testing a few things at once. And so we've tested issues in relation to people being exposed to biological agents, Sydneysiders won't be surprised to know that we've tested the issues in relation to water contamination. Linked with those are also trials or testing of responsiveness in relation to the counter-terrorist activities as well, although that's obviously not the major part of the health response.

Norman Swan: And so when people turn up at these, you've got made-up patients, not just acting with a label on their shirts, they've actually got skin lesions and things like that?

Andrew Wilson: We try and make it as realistic as possible at the time. People need to be able to identify what's going on.

Norman Swan: And so the firemen or whoever the first person is to arrive, has to make an assessment?

Andrew Wilson: They have to have some clue, they have to be able to make an assessment of the type of hazard they might be exposed to, they're not actually told, 'You're going to go along there and there's going to be a fire', because they'll obviously go prepared to do that. There has to be actually an assessment of their ability to assess what the particular disaster or exposure might be.

Norman Swan: And have you breathed a sigh of relief that you've found mistakes being made then that you could correct now that you're glad wouldn't have been made on the day?

Andrew Wilson: The best part about it all, desktop planning and scenario planning is a relief generally that you've had an opportunity to go through it in advance, because you always find some parts of the system that break down, and it's an opportunity to get it right.

Norman Swan: What's happening with the hospitals in the Sydney area?

Andrew Wilson: Some of the hospitals will have a much greater role than others. For instance, the Concord Hospital is the designated hospital for -

Norman Swan: So for people outside Sydney that's the hospital very near the Homebush Stadium.

Andrew Wilson: That's right. That hospital will be the hospital that will deal with the actual participants and issues flowing directly from the Homebush, the major site.

Norman Swan: So if somebody breaks an ankle, an athlete, they'll go to Concord Hospital.

Andrew Wilson: That's right.

Norman Swan: Are they bringing their own doctors with them? Are they going to be able to practice medicine?

Andrew Wilson: A very large number of doctors come with most of the teams. Most of the teams come with some medical attachment. Some of them have very extensive medical teams, including physiotherapists, etc.

Norman Swan: What about their licences to practice, how do you deal with that?

Andrew Wilson: The legislation in New South Wales has been modified to allow for temporary registration of doctors in this situation. They'll have very limited prescribing rights to be able to dispense a range of medications to people within the confines of the Olympic Village.

Norman Swan: And are you downscaling activity in other hospitals to cope with what people are touting as a traffic crisis and also the need for maybe disaster capabilities?

Andrew Wilson: We're not planning a downsizing of activity in the hospital. However there's an inevitable flow-on from a whole range of other things which are occurring that will lead to that. So we've got a situation where, as people will know, there are cheap airfares being offered out of Sydney, and the conference season is still hot in the Northern Hemisphere, so I'm sure there will be people who will take advantage of that. There are people who are taking leave to participate or to go into the Games, so there will inevitably be some degree of slowdown in activity, but it's not our intention that that should occur.

Norman Swan: What has happened at previous Olympics to give you cause for either relaxation or concern? Are there public health stories from previous Olympics, apart from say, the bomb in Atlanta?

Andrew Wilson: There's information from both Atlanta and Barcelona that reassures us about the level of demand that the Games are likely to place on health facilities.

Norman Swan: Because basically these people are fit.

Andrew Wilson: That's right. And also the people who are coming to the city, the spectators, who are the other source of potential contacts in the main are only here for a relatively short period of time. But if you take Atlanta, for example, the total impact over that period of time was less than 100 admissions, somewhere around 60 admissions to hospital occurring as a result of that. It's varied a bit from Game to Game, depending on how they've actually configured their services. So like Atlanta, we will have a very substantial presence 'inside the fence', was we use it as a description of activities which are occurring around the actual events and there is a very substantial poly clinic on the Homebush site, there are a range of first aid stations which will be able to offer quite a sophisticated level of first aid and emergency care at those facilities. And so we will avoid, for instance what happened in Barcelona where there was a large amount of transfer of patients or people from venues to hospitals through that process.

Norman Swan: So does the Chief Health Officer get to stand inside the fence at all the activities?

Andrew Wilson: Unfortunately it doesn't come with that guarantee, no.

Norman Swan: But you're staying in town?

Andrew Wilson: Unfortunately I also have to stay in town.

Norman Swan: Andrew Wilson thank you.

Dr Andrew Wilson who's the Chief Health Officer in the New South Wales Health Department; gratifying to know that he is hanging around.

Guests

Dr. Andrew Wilson

Chief Health Officer,New South Wales Health Department,Sydney, New South Wales